There are elements of the reforms Labour should support. Others are bad for NHS patients and should be opposed. NHS Foundation hospitals offer the highest levels of efficiency and quality so it's a good idea to rapidly make them universal. It's a bad idea to let hospitals off the accountability hook by abolishing the national targets that have driven better clinical outcomes and lower waiting times.

Cutting waste is a good idea but it's a bad idea to assume that NHS structural change saves cash rather than costing it. Abolishing primary care trusts and creating more GP consortiums to replace them hardly sounds like a recipe for reducing bureaucracy.

There's a chasm between the cost of making change and the cash available for it. The NHS budget will fall, not rise, in the next few years so it's relying on £20bn of efficiency savings to make ends meet. Structural change can only distract it from doing so. Similarly, it's a good idea to get politicians out of day-to-day NHS management, but it's a bad idea to move power sideways to a national commissioning board when it should be moved downwards to where health decisions are taken, in local services serving local communities.

Getting family doctors to own the financial consequences of their prescribing, treating and referring decisions is a good idea. But it's a bad idea to weaken public accountability over £80bn of public money and to assume that GPs can easily do the complex business of commissioning local services.

Ironically, the original coalition agreement, by giving local authorities a bigger role in commissioning health services, at a stroke would have improved local accountability and bridged the health/social care divide. Labour should resurrect and champion that idea.

Labour should box equally smart on coalition plans to promote open competition in the NHS. When I introduced private sector providers, some said it would be the end of the health service as we knew it. In fact it strengthened the NHS. Where new providers were brought in to provide NHS services, waiting times and death rates fell faster than where they weren't. Labour should promote a legal level playing field based on the interests of patients, not providers. But that requires proper planning not a free-for-all. So while it is a good idea to extend competition, in the NHS it is a bad idea to allow this to fragment local services or to be on the basis of price rather than quality. Market mechanisms can work in healthcare but only when properly managed.

There are enough nitty-gritty issues for Labour to get its teeth into here. The bigger question to pose is whether these reforms can possibly meet the challenge the NHS faces from an explosion in chronic diseases, such as diabetes. That calls for policies that integrate services rather than fragment them, and for more focus on prevention. It argues for patients being empowered to take greater charge of their health. This is the future health policy agenda. Labour should own it.

Opposition to change is always easy. But it would be unwise for Labour's stance on the government's proposals to suggest we are conceding rather than contesting the reform territory. That might be comfortable for now. But it fails to answer the question voters are bound to ask later – so, what do you stand for? The government's changes provide an opportunity for Labour to restake our claim to be the party of progressive radical reform. It is only when we are that we win.